Provider Demographics
NPI:1083029557
Name:THE DENTIST OFFICE PC
Entity type:Organization
Organization Name:THE DENTIST OFFICE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:O
Authorized Official - Last Name:FALAIYE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:703-336-7098
Mailing Address - Street 1:8808F PEAR TREE VILLAGE CT
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22309-4221
Mailing Address - Country:US
Mailing Address - Phone:703-499-9006
Mailing Address - Fax:703-441-7927
Practice Address - Street 1:8808F PEAR TREE VILLAGE CT
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22309-4221
Practice Address - Country:US
Practice Address - Phone:703-499-9006
Practice Address - Fax:703-441-7927
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-24
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014102371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty